Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 156FX1700X | Ocularist |
NPI | 1588732705 |
---|---|
Provider Name | Mrs. Elise Cox Pratt |
First Address | Birmingham, AL 35233-1856 |
Second Address | Birmingham, AL 35233-1856 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 04/12/2006 |
Last Update Date | 18/12/2014 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
009918060 | (05) | AL |